Creating healthy, productive organizations: underlying workplace conditions have a much greater impact on employees' productivity and health than individual behaviors. EA professionals can help redefine workplace health as a strategic issue that affects corporate costs and organizational results.

Stress, burnout, work-life imbalance, interpersonal conflict, and other symptoms of unhealthy work environments are contributing to rising healthcare costs and lower productivity and ringing alarm bells in executive suites. Many businesses are turning to workplace wellness initiatives for relief, but these offer only partial solutions because they target individual health behaviors rather than the underlying working conditions that pose health risks.

Employee assistance professionals are on the front lines of helping employees deal with the consequences of unhealthy workplaces and can play a pivotal role in finding solutions. EA professionals are ideally positioned to give voice to the experiences of employees who have become disengaged from their work or even hostile to it because of toxic workplace relations, unsupportive supervisors, and/or unrealistic job pressures. To leverage these insights and add value to EAPs, EA professionals must do three things.

First, they must be able to redefine employee health concerns as strategic issues affecting corporate costs and productivity; otherwise, senior managers won't listen. Second, they must understand that solid research evidence corroborates the employee perspectives they bring to the attention of senior management. Finally, they must cooperate with professionals in workplace health, human resources, occupational health and safety, and organizational development to craft comprehensive interventions that improve the health of the entire organization.

HEALTH AS A STRATEGIC ISSUE

The costs of unhealthy and unsafe workplaces have been well documented and are calculated in terms of absenteeism, accidents, rising drug benefits costs, turnover, reduced job commitment and satisfaction, higher healthcare and healthcare-related costs, and lost productivity One U.S. estimate suggests that stress, depression, anxiety, violence at work, harassment, and intimidation account for nearly one-fifth of all health-related problems at work, with a quarter of these problems resulting in absences of two or more weeks. Another estimate, derived from Australian workers' compensation data, posits that unhealthy workplaces account tar 20 percent of total healthcare costs.

Researchers are beginning to recognize the need to develop an approach to workplace health that moves beyond individual workers' health outcomes and examines the underlying problems in the work environment. Experts in occupational health and safety, workplace health promotion, and epidemiology agree that successful health interventions must target intrinsic workplace and organizational factors. The Institute for Work and Health (Canada) argues that the limitations of workplace health promotion programs can be remedied by promoting the workplace determinants of health, which address job, organizational, and work environment causes of health and wellness. Other experts use the concept of a "health-promoting workplace" to balance customer expectations, organizational goals, employee skills, and health needs.

The most promising feature of the emerging healthy workplace perspective is its attempt to link healthy work environments with improved health out comes for individual employees and improved business results. This widens the agenda to the entire organization--its values, people practices, work systems, and performance. While we need a better understanding of exactly how healthy conditions in workplaces contribute to organizational performance, this link offers the greatest potential to convince managers and business owners that investing in organizational health and wellness makes good business sense.

Redefining workplace health in organizational terms transforms it from a policy or program into a core characteristic of how a business or public service operates. A healthy organization has a work environment that contributes to employee health and high performance. One attribute of a healthy organization, according to the U.S. National Institute tar Occupational Safety and Health, is an organizational climate in which employees feel valued and are able to resolve conflicts among themselves. By helping managers make the link between a healthy work environment and better business results, EA professionals will reframe health as a strategic issue and position the EAP as a valued partner in finding solutions.

VALIDATE EMPLOYEES' EXPERIENCES

Employees are the best judges of whether a workplace is healthy; indeed, employees' perceptions of the quality of their work environment are useful in diagnosing job satisfaction, commitment, absenteeism, and individual performance problems. A survey by Canadian Policy Research Networks (a non-partisan public policy think tank) found that 15.6 percent of Canadian employees disagreed or strongly disagreed with the statement that "my work environment is healthy." In contrast, 18.3 percent strongly agreed, 56 percent agreed, and 10.2 percent were neutral

Given that roughly one in six employees considers his/her workplace unhealthy, it is worth examining specific job characteristics to determine the extent to which they correlate with employees' perceptions of healthy work environments. A clear and consistent picture emerges: trust, respect, a safe work environment, good co-worker communication, work-family balance, job security, good supervision, job autonomy, and friendly and helpful co-workers correlate highly with perceptions of a healthy work environment. In the absence of any of these conditions, a workplace will be perceived by employees to be less healthy.

Granted, individual workers who perceive their workplace to be healthy still need to take responsibility for reducing their personal health risks, and employers can support them through a range of health promotion programs. The biggest sustainable gains in employee health and productivity result not from these programs, however, but from changing the overall work environment.

Hundreds of studies document the direct and indirect benefits of healthy work environments for both individuals and organizations. We know, for example, that healthy jobs and workplaces contribute to an individual's physical, psychological, and social well-being. These benefits ripple across the entire organization through higher job satisfaction, lower absenteeism and turnover, improved job performance, lower accident rates, and reduced health benefit and workers' compensation costs.

One of the biggest challenges in creating and maintaining a healthy workplace is that no single source of information can provide an accurate and thorough assessment of workplace health, especially in large and complex organizations. Employee surveys, while useful for measuring key indicators such as job satisfaction, engagement, and stress, need to be corroborated and complemented with other sources of reformation. Absenteeism data can be misleading, especially if work pressures or absenteeism management practices encourage "presenteeism"--a term used to describe the practice of employees coming to work but not devoting complete attention to their jobs.

Insights drawn from EAP case data can provide valuable information about the causes and consequences of unhealthy work environments. Most usefully, an EA professional's perspective can add a needed human dimension to the results of employee surveys.

EA PROFESSIONALS AS CHANGE AGENTS

Figure 2 presents guiding principles for creating healthy workplaces. Implicit in these eight guidelines, drawn from existing literature, is a model of organizational change that incorporates well-established principles for individual health promotion. When put into practice, however, individual health promotion objectives usually trump organizational change objectives. More emphasis is needed on organizational issues, which EA professionals can help provide by communicating to senior management the organizational implications of major EAP utilization trends.

There are two kinds of organizational change: transformational and superficial. Creating a healthy organization exemplifies transformational change; introducing a fitness program or a policy on flexible work schedules represents superficial change.

Transformational change does not require a sudden leap from an old organizational model to a new one. The shift to a new culture and work system takes time--usually three to five years--and often results from a sequence of small steps that are guided by a compelling vision. EA professionals can contribute to this process by identifying the deeper changes required in organizational systems and helping to develop and implement action plans.

EA professionals will need to identify and confront long-standing organizational and professional "silos" that stand in the way of creating broad-based healthy workplace change agendas. By teaming up with colleagues in occupational health, employee wellness, and human resources, EA professionals can offer insights and support to front-line managers an supervisors who have to make needed changes. The EA professional brings to this discussion a client's perspective on what needs fixing and an informed judgment about the costs of reaction.

One important reason why change continues to receive so much attention in management literature is that most transformational change initiatives fail. Estimates suggest success rates of only 25 to 33 percent in reaching intended change goals. This is all the more reason [or EA professionals and other champions of healthy workplaces to glean whatever lessons they can from a wide range of organizational experiences--including those of EAPs.

Figure 2 sets out principles, not an overall prescription, because each work place has different priorities, needs, and objectives. There is no one best way to create a healthy organization and no neat list of best practices that define such an organizational state. these principles can provide a basis for workplace discussions among EA professionals and other change agents planning ways to advance a healthy organization agenda. They are intended to stimulate strategic thinking about how to design and initiate changes that will flourish over time.

EA professionals can take a major step in the direction of creating healthier workplaces by articulating their own vision of a future workplace that is both healthy and productive, drawing on their unique vantage point within the organization. This healthy workplace vision can identify opportunities where EA professionals can take a leadership role. Indeed, the value of EA professionals very likely will be measured in the future by their contributions to successful healthy workplace strategies.

FIGURE 1

Correlation Between Employees' Perceptions of a Healthy
Work Environment and Selected Job Characteristics

                                                Percent Who Agree or
                                                Strongly Agree that
                                                Work Environment is
Job Characteristic                              Healthy

Trust employer to treat me fairly                        82
Employer treats me with respect                          81
Safe work environment                                    80
Good communication among co-workers                      79
Job allows me to balance work and family/life            78
Good job security                                        78
Good relationship with supervisor                        77
Freedom to decide how to do work                         77
Friendly and helpful co-workers                          75

SOURCE: Lowe, G., H. Shannon, and G. Schellenberg. 2003. "Correlates of
employees' perceptions of a healthy work environment." American Journal
of Health Promotion 17 (6): 390-399.

Note: Table made from bar graph.

FIGURE 2

Guiding Principles for Healthy Workplaces

1. Supportive culture and values. Creating and maintaining a healthy workplace requires a supportive culture that clearly values employees and is trust-based. Ideally, the process of creating a healthy workplace should be designed to strengthen trust.

2. Leadership. Commitment from top management is critical and must take the form of visible leadership on health issues. Employees judge commitment by the actions of the chief executive and the executive team. Leadership must also be exercised throughout the organization, especially by line managers.

3. Broad definition of health. Good mental and physical health means more than the absence of illness, injury, and disease, It also means leading a balanced life, developing one's potential, making a meaningful contribution to the organization, and having a say in workplace decisions.

4. Participative team approach. Implementing a healthy workplace strategy requires an integrated approach guided by teams that include representatives from management, health and safety, human resources, employees, and unions. This is not just a health issue. Direct employee involvement in all stages is especially critical to success.

5. Customized plan, Collaboratively develop a workplace health policy and action plan with clear goals. The policy and plan must be tailored to the business context, workforce characteristics, and documented gaps in the work environment. Learn from each change introduced and refine the plan accordingly.

6. Link to strategic goals. Clearly link health issues and outcomes to the organization's strategic goals. Integrate health and well-being objectives into the organization's business planning process so that, over time, all management decisions take health into account.

7. Ongoing support, Allocate resources that ensure continuity to healthy workplace actions. Provide training, especially to managers, to sustain the initiative and embed health into organizational operations.

8. Evaluation and communication. Open and continuous communication is a key success factor in any organizational change initiative. Consistently evaluate outcomes and keep top management informed about the impact of healthy workplace issues on business results,

SOURCE: Lowe, G, 2004, "Healthy Workplace Strategies: Creating Change and Achieving Results." Discussion paper prepared for Health Canada. Available in pdf format at www.grahamlowe.ca.

Graham Lowe is president of the Graham Lowe Group Inc. (www.grahamlowe.ca), a workplace research and consulting firm based in British Columbia, Canada. He has been a professor of sociology at the University of Alberta since 1979 and is a research associate at Canadian Policy Research Networks. His numerous publications include The Quality of Work: A People Centered Agenda (Oxford University Press, 2000). He can be reached by e-mail at [e-mail] or fly phone at (250) 717- 7371.